Individual provider Active NPI

Nagi Ibrahim Eltemsah, MD

  • Pediatrics Physician
  • Jersey City, NJ
National Provider Identifier
1568535367
Registry record updated Nov 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
25MA06245800 Issued in NJ
Practice address
2775 Kennedy Blvd
Jersey City, NJ 07306
Phone
(201) 559-5536
NPI assigned
Nov 17, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 7, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 25MA06245800 NJ Primary

Addresses

Primary practice location

2775 Kennedy Blvd
Jersey City, NJ 07306

Mailing address

2775 Kennedy Blvd
Jersey City, NJ 07306
Phone (201) 559-5536

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110526000489 NJ Practitioner - General PracticePractitioner - Pediatric Medicine 7911184015 Practice locations: Jersey City, NJ

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Jersey City Medical Center Past Accepting new patients
Sahara Medical Associates, PC PastSince Nov 12, 2023 Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/GBAHDD/Endpoint/GBAHDD

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699315200000",
    "number": "1568535367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2775 KENNEDY BLVD",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "07306",
            "telephone_number": "201-559-5536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2775 KENNEDY BLVD",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "07306",
            "telephone_number": "201-559-5536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELTEMSAH",
        "first_name": "NAGI",
        "middle_name": "IBRAHIM",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-17",
        "last_updated": "2023-11-07",
        "certification_date": "2023-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NJ",
            "license": "25MA06245800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jersey City, NJ

Sources for this page

Verify at the official NPI Registry.